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Commotio cordis: sudden death due to chest wall impact in sports
  1. Department of Forensic Medicine, University of Dundee
  2. Dundee DD1 4HN, UK

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Editor,—In his editorial,1 Link comments that 70 deaths have been reported from commotio cordis while playing American sports since the late 1970s (mostly baseball, ice hockey, and American football), but there have been no reported deaths from this cause while playing cricket. Haq2 raises the possibility of such a fatality occurring during a cricket match in Kentucky in 1970, but there are no reports of deaths occurring in Britain, where cricket is a popular summer sport. This may surprise many, as a cricket ball is of similar size, weight, and hardness to an American baseball, and commonly travels at similar speeds.

As Link suggests, there is probably a relative lack of awareness of the phenomenon of commotio cordis outside the United States. However, the dynamics of cricket are such that impacts of balls to the central chest of batsmen are rare. A baseball is “pitched” from a distance of 20 yards and aimed, without bouncing, to closely pass the batter between chest and knee height. In contrast, a cricket ball is “bowled” by a straight arm, windmill-type action from a distance of 22 yards and bounced once towards three 28" high wooden stumps, usually passing the batsman below waist level. This lower trajectory, as well as the more side on stance of the batsman, makes central chest impact by the ball considerably less frequent than in baseball. Only infrequently is the cricket ball bowled at chest height, either without bouncing (a “full toss”, recently outlawed), or deliberately bounced fast and short to intimidate the batsman (a “bouncer”). The batsman’s usual response is to take simple evasive action by ducking or swaying. The alternative is to play an aggressive shot in which the bat and shoulders (of a right handed batsman) are swung from right to left in a high horizontal arc, aiming to hook the ball from in front of the chest in an action broadly resembling a baseball shot. Only in this infrequent situation is the batsman likely to be struck in the central chest and placed at risk of commotio cordis. It is perhaps for this reason that chest protection is rarely worn by cricket batsmen, except when facing the fastest bowlers at the highest professional level.

Recent research has provided a better understanding of the dynamics of chest impact.3 Increasing awareness of the dangers of low energy chest wall impact has encouraged use of appropriate protective measures and this will reduce the incidence of these most tragic sporting deaths.4 Although there is less risk of commotio cordis in cricket than in baseball or ice hockey, the lessons learnt from American sports fatalities and the precautions necessary to safeguard the young participants are transferrable to other sports.